Gregory S Puckett, DMD
Individual provider Active NPI Dentist · Vine Grove, KY
NPI 1790965374 · NPPES record last updated Jan 14, 2010
Key facts
- NPI
- 1790965374
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6383 (KY)
- Practice address
- 517 Highland Ave.
Vine Grove, KY 40175-1461 - Phone
- (270) 877-5553
- NPI assigned
- Nov 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6383 | KY | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6383 | KY | Yes |
Addresses
Primary practice location
517 Highland Ave.
Vine Grove, KY 40175-1461
Mailing address
517 Highland Ave
Vine Grove, KY 40175-1461
Phone (270) 877-5553
Other providers in Vine Grove, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.